w-2: Searching for Good News in a Bush Victory

It is difficult to overstate the damage that George Bush can do to the nation's health care and biomedical science in his second term. Long after the shock of a Bush victory - yes, he did win this time - has faded in the minds of Americans, the world will have to cope with this election. What are the implications for medicine and science? Hint: you won't like any of them ... this term, Bush is empowered, under pressure from conservative protestants, and a lame duck to boot.

Kiss pharmaceutical reform goodbye. There is no way George Bush will do any less for pharmaceutical companies than he has done for oil companies. In fact, if anything, the election will draw a more direct analogy between oil and drugs: Bush now has no reason to fear reprisals from those who oppose the drug industry's extraordinary pricing structure in the United States. Bush's cronies may not yet directly profit from the drug industry in the way that they do from Haliburton, but you can bet plenty of Bush appointees are thinking seriously about their future in biomedical lobbying. Pharma will need the President as its collusion with FDA officians and others comes to the fore. Pharma knew what it was buying with Bush, "make no mistake." Any reform effort that included drugs from Canada, including the one Bush said he was "looking at," and any effort to seriously curtail the price of drugs for seniors, will fall prey to the three million vote margin of victory. Drugs will cost more and fewer people will be able to afford them.

International efforts to, well, do anything that Bush opposes are in real trouble. Unfettered international drug research is part of the bargain. Advocates for research subjects have lobbied the WHO and the UN - and those organizations have lobbied the US - to stop the most lopsided and colonialist drug industry research efforts in developing nations. How many research programs in Africa have really rewarded research subjects with any kind of improvement in healthcare quality, even for the disease being researched? Not many.

Healthcare access and insurance reform? Look, no one wants to be pessimistic. Health insurance reform is long-overdue and we in the U.S. have to find a way to provide affordable healthcare to tens of millions of U.S. uninsured. Here's a great Bush solution that lots of Americans seem to support: tort reform! All we have to do is stop those big lawsuits against physicians, and we can save a whole lot of ... wait ... what? Only 3% of the cost of healthcare is in any way related to lawsuits? Ok, wait, so maybe stopping patients from recovering the damages juries want to award them in cases of malpractice won't have much financial effect ... except on physician and lawyer salaries. But Republican voters aren't weeping about that. What they will cry about is the bills that they, and all of us, will have to pay as we watch emergency rooms continue to be the provider of healthcare for the poor, the sick and the legions of uninsured - hundreds of millions of dollars in unnecessary treatment. Those costs have to come out of somewhere. Just watch your premiums skyrocket, guys. Red states will also bleed red ... ink. Maybe there will be a direct correlation between insurance increases and prices at the gas pump! Who knew anything but college tuition could go up so fast?<[> Enough has been written about Bush's war on science to establish beyond question in the mind of anyone in a blue state that Bush, as a final-term president with uniform control of the U.S. government, will be able to quietly support all sorts of insidious efforts around the nation. Just as gay marriage is quietly being outlawed around the nation, look for Bush to lend support of several kinds to state efforts to roll back protection of women's reproductive healthcare. Bush could care less about evolution, but the "intelligent design" movement can rest easy that Oklahoma's new senator and many other new elected officials around the nation are supporters of creationism in the classroom.

There is still one winable battle, although I fear it is not in Ohio or Iowa. The battle is to reform or reject the President's Council on Bioethics. Leon Kass is no doubt gearing up to lead all the President's ethicists for another term of 'moral seriousness'. He must be put on notice that bioethics cannot afford four more years of feckless, xenophobic neocon posturing, even if it is delivered with austerity. Kass should have apologized to the nation for selling the proceedings of his Council through a for-profit, conservative commercial press. He should not have abused the reputation of one of the world's most prestigious biomedical scientists, Elizabeth Blackburn, named by Bush to the PCB and then shown the door under the pretense that she did not attend enough meetings. Blackburn was by all accounts one of the most active participants in the dialog about stem cell research, emailing Kass and others constantly. Kass could not find another way to defend the PCB against the charge that it sat idly by while the Bush administration (or he) fired one of two moderate scholars, and "retired" the other one, replacing both with ultraconservatives. So Kass resorted to distortion and blame in broad public view. To this day he has neither apologized nor attempted any kind of rapprochement with Blackburn or for that matter with anyone more moderate than William Kristol.

The new generation of conservative bioethicists seems dedicated to the proposition that debate is the enemy, or more accurately that opponents are best left ignored. The PCB virtually ignores the bioethics literature in its writing and anthologies. There are passing references to those who agree with them on matters at hand, most noticeably Carl Elliott, but it has become a hallmark of Bush Bioethics that no position is argued by the PCB while there are people 'in the room' with whom one must argue, unless absolutely necessary. This Council must go, or at least be made to play a peripheral role in the bioethics scene, unless it is radically remade with voices from both sides of the aisle. Supposedly even Wesley Smith agrees that there should be such voices. Now it is time for the American Enterprise Institute's Hertog Fellow Leon Kass to act with courage so that we really can have a "richer" bioethics.

It is a pretty terrible day for those of us in bioethics who supported the right to choose, hES research, and dozens of other areas I have not taken the space to discuss. But the real tragedy would be if bioethics did not take from this mess the lesson that not all battles must be fought nationally. State-by-state we will see the new changes made in bioethics-relevant law. California's Proposition 71 is just the beginning of some very important new shifts that deserve some real pragmatic consideration. Bioethics may not be as prestigious when it is fought out in the states, but that is where the battles now lie, at least for four more years. - Glenn McGee (UPDATED 11/3;11/20 )